Document Detail


Prognostic factors for radiosurgery treatment of trigeminal neuralgia.
MedLine Citation:
PMID:  18580781     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Trigeminal neuralgia treatment results are thought to be highly dependent upon selection criteria. We retrospectively analyzed a series of patients to determine the likelihood of treatment success for patients treated with radiosurgery. METHODS: A retrospective analysis of 82 patients treated with linear accelerator radiosurgery was undertaken with a median follow-up period of 18 months. Patients were evaluated with a standard inventory using the Barrow Neurological Institute pain scale as the primary means of outcome measurement. Patients were treated with a linear accelerator using a single isocenter plan delivered via a 4-mm collimator, typically with seven noncoplanar arcs to a peak dose of 85 or 90 Gy in primary treatments and 60 Gy in retreatments. The primary target was the cisternal component of the trigeminal nerve. Posttreatment outcomes were analyzed in light of pretreatment patient characteristics, including age, sex, anticonvulsant responsiveness, quality and pattern of pain, length of disease, number of previous procedures, and radiation dose exposure to the root entry zone. Univariate analysis and multivariate logistic regression analysis were used to determine the prognostic significance of various pretreatment variables. RESULTS: Good results as defined by a Barrow Neurological Institute outcome score of IIIb or better were seen in 85.3% of patients. Excellent results as defined by a Barrow Neurological Institute outcome score of I were seen in 49% of patients. The median time to satisfactory improvement of pain was 4 weeks. Only one variable, sensitivity to anticonvulsant medication, was found to be statistically significant in both univariate (P = 0.003) and multivariate analysis (P = 0.025). All other variables analyzed failed to reach statistical significance. Complications were not common, with seven patients (8.5%) developing new-onset hypoesthesia and two patients (2%) developing dry eye symptoms. CONCLUSION: Anticonvulsant responsiveness is the single most important prognostic indicator of treatment success for patients presenting with facial pain. Other predictive factors generally failed to reach statistical significance. Linear accelerator radiosurgery for trigeminal neuralgia is a safe and effective treatment for well-selected patients, with results similar to those obtained with gamma unit radiosurgery.
Authors:
Joseph C T Chen; Hugh E Greathouse; Michael R Girvigian; Michael J Miller; Amy Liu; Javad Rahimian
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  62     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-06-26     Completed Date:  2008-12-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  A53-60; discussion A60-1     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Southern California Permanente Medical Group and Kaiser Foundation, Los Angeles Medical Center, Los Angeles, California, USA. jctchen@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prognosis
Radiosurgery / methods*
Retrospective Studies
Trigeminal Neuralgia / diagnosis*,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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